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MOH/GHESKIO PEPFAR
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  1. MOH/GHESKIO PEPFAR Care and Treatment overview July 21, 2010

  2. Objectives/Outcomes HIV VCT Palliative care, PMTCT, TB/HIV, OVC, ART Training Treatment M&E and adherence support Program adjustment after January,12 Network need assessment Action required New initiatives Summary

  3. HSA, Jérémie • HIC, Cayes • HUJ, Cap • HSM, Jacmel • HND, Petit Goave • Arcachon 32 • Sigueneau • E. Germain SITES COVERED FOR TREATMENT AND CARE 22 sites (16 PEPFAR and 6 Global Fund) Fame Pereo Fermathe GHESKIO IMIS Bernard Mews Bombardopolis HCH La Gonave

  4. Provide palliative care to 59,000 patients A total of 66,223 patients received Palliative Care with a percentage of 112% at 9 months. Provide ART to 3,100 new patients: MOH/GHESKIO Network enrolled a total of 2,622 new patient on ART with a percentage of 85% at 9 months Maintain a total 15,750 active on ART : - MOH/GHESKIO network maintain a total of 13,696 active patients on ART with a percentage of 87% and placed a total of 17,935 patients on ART. Milestones achieved in MOH/GHESKIO network (June,30,2010)

  5. Care and Treatment outcome

  6. Multidisciplinary mobile teams assure monitoring and evaluation activities by offering: Regular Quality Assurance and Quality Control QA/QC of all the services package (VCT,TB/VIH, ART, Pediatric ART care, Laboratory, Pharmacist, PMTCT ) Laboratory maintenance evaluation and recommendation Reinforcement of PMTCT and Pediatrics care Supervision of blood drawing for DBS-PCR Evaluation of patients for therapeutic failure Data Collection for loss to follow up, adherence, deaths Monitoring and Evaluation

  7. To date: 1095 viral load tests were performed. 243 patients have HIV-1 genotyping testing; 91% of them were positive for drug resistant virus. Network resistance surveillance

  8. Assumption The optimal time to initiate ART in adults who are infected by HIV remains uncertain Conclusion Early initiation of antiretroviral therapy decreased the rates of death and incident tuberculosis. Access to antiretroviral therapy should be expanded to include all HIV infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources. Lesson learned N Engl J Med 363;3 July,15,2010

  9. After the earthquake, we had to: Work in difficult conditions (GHESKIO lost 70% of workspace) Conduct rapid need assessment with sites located in affected regions (West and South West) Strengthen contacts with collaborative sites to identify patients requiring care. Set up additional points of drug delivery Launch contingency plan Expand service range (Trauma field hospital/post-op-Rehabilitation Center, Refugees camp, TB Field hospital) New Tasks Post-earthquake

  10. GHESKIO learned a lot from 30 years of recurrent political problems, social unrest and natural disasters (4 successive hurricanes within 4 weeks in 2008) We developed and improved a contingency PLAN with various codes according to the urgency of the situation We make sure that our TB or ART patients have a 2-week extra supply of drug Each patient has an electronic medical chart capable of providing all essential clinical informationincluding date of next visit and trace those who missed a visit and transmit info to field worker; there is a field worker for each 100 patients All patients have a “correspondent” capable to locate their new address Lessons learned

  11. New initiatives

  12. In the first part of the PEPFAR program, our effort was particularly dedicated to improve the quality of care delivered to AIDS patients. To maintain these results, we have to provide a more comprehensive approach by introducing new interventions to address global health issues. Conclusion